Provider Demographics
NPI:1720840481
Name:FAMILY RESTORATION LLC
Entity Type:Organization
Organization Name:FAMILY RESTORATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIEL-MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MBA
Authorized Official - Phone:713-865-2684
Mailing Address - Street 1:3422 BUSINESS CENTER DR STE 106 #137
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4159
Mailing Address - Country:US
Mailing Address - Phone:281-692-1778
Mailing Address - Fax:270-203-0587
Practice Address - Street 1:3 HUNTINGTON BEND DR.
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578
Practice Address - Country:US
Practice Address - Phone:281-692-1778
Practice Address - Fax:270-203-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management